Privacy and Confidentiality
Privacy and confidentiality are essential to ensuring the first bioethics principle – autonomy. These terms refer to protection against violation of one’s person in any way they might perceive violation and unauthorized access to a patient’s information.
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Privacy and Confidentiality Ta-Chih Tan and Ahmed Ammar
6.1
Introduction
Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. (Hippocrates)
A patient’s right to privacy and confidentiality is a well-known medical concept, already incorporated in the Hippocratic Oath, as well as in numerous medical professional codes (Higgins 1989; Patient’s Bill of Rights; Thompson 1979; Umansky et al. 2011). As easy at it seems to protect a patient’s privacy and confidentiality, in reality, there are many situations in clinical daily life where both aspects are at risk, and we healthcare providers are not always fully aware of it. Clearly, patients expect their privacy to be protected (Akyüz and Erdemir 2013), and this is central to value-based medicine. In certain well-studied cases, the known facts a doctor has about a patient concern a physical threat to other people (Stone 1976). In these cases, a conflict arises – who (the patient) or what (the principle of justice) should we protect? Less egregious and less visible but more common examples of privacy breaches include everyday conversations between colleagues in public places and the way patients’ files are kept (Howe and Bernstein 2014).
T.-C. Tan, MD (*) Division of Pediatric Neurosurgery, Department of Pediatrics, HSK-Wiesbaden, Ludwig-Erhard-Strasse 100, Wiesbaden 65199, Germany e-mail: [email protected] A. Ammar, MBChB, DMSc, FICS, FACS, FAANS Department of Neurosurgery, King Fahd University Hospital, Dammam University, 40121, Al Khobar 31952, Saudi Arabia e-mail: [email protected] A. Ammar, M. Bernstein (eds.), Neurosurgical Ethics in Practice: Value-based Medicine, DOI 10.1007/978-3-642-54980-9_6, © Springer-Verlag Berlin Heidelberg 2014
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Furthermore, privacy and confidentiality are ever-changing concepts, subject to technological advances, culture, society, legislation, and, last but not least, autonomy of a patient, which has actually increased over time, thanks to the law and patients’ easier access to medical information (Ammar 1997; Higgins 1989; Thompson 1979). Examples of new issues which have evolved include the acquisition and securing of molecular information in surgical patients (Bernstein et al. 2004). In order to ensure a patients’ autonomy, they must be certain that privacy and confidentiality of their information is safeguarded.
Pearl
A patient’s right to privacy and confidentiality is an ever-changing concept, based on culture, society, and legislation, but it derives directly from a patient’s right to autonomy. The awareness in daily clinical practice about protecting a patient’s privacy and confidentiality is not yet optimal.
6.2
Illustrative Cases
Case 1 (Speaking About a Patient in a Public Place)
Two colleagues talk jokingly about an upcoming procedure on a patient in an elevator. The daughter of the patient is standin
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